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The little girl laid on the couch in the late morning, her oxygen flowing through her nasal cannula, her formula running through her feeding tube, and her IVs delivering a steady stream of fluids and medication into her veins. She was awake and aware, which was unusual. Typically Daddy kept her mildly to heavily sedated. Daddy had just changed her diaper and, after washing his hands, he sat down beside her. “Daddy has a special treat for his little girl today,” he said with a smile. “Would you like to go outside for a walk in your stroller?”The little girl nodded eagerly. “Yes, please, Daddy.” Even though she was embarrassed to be seen in public in a stroller with a feeding tube and oxygen, she jumped at the chance to leave the house. She had come to realize she needed to escape, and this might be her only opportunity to get help. Perhaps from her stroller she could flag down a neighbor who could help her get away from her Daddy. He kept her sleepy and helpless, and the medical interventions he was forcing upon her were steadily increasing. She knew she needed to get away, but her Daddy would never allow her to leave if she asked. He loved having his baby girl completely dependent. No, her only chance was to find a stranger who could help.“We will keep your feeding tube in, of course,” said Daddy. But I’ll disconnect it from your formula. I’ll also disconnect your IVs. Before I do, I’m going to give you a flush of light sedation. That’ll help you stay calm and quiet on our walk. You’ll also have to wear your oxygen mask instead of your cannula just to help you remember not to talk to anyone.”The little girl frowned. She had hoped her Daddy would allow her to leave the house and ride in her stroller without being sedated. She knew she’d have to push hard through the medicine if she was going to alert a stranger and try to get help. She also hoped she could use her oxygen cannula, which went up her nostrils but left her mouth free, rather than the oxygen mask, which fully covered her mouth and nose. Getting someone’s attention through sedation and the mask would be very difficult.Daddy busied himself disconnecting her from her formula and stopping the flow on her IV pump. He loaded a syringe with a mild sedative. While he didn’t want his baby to be fully asleep on their walk, he also didn’t want her to be wide awake. He couldn’t risk her speaking to anyone or, god forbid, asking for help. The sedation combined with the oxygen mask covering her mouth and nose would surely keep her silent. He decided he’d also load a small canister of anesthetic gas into the back of her stroller just in case he needed to put her to sleep quickly. He inserted the needle into the port on her IV and injected her. “Here comes your sedation, baby.” He watched her face and smiled as her eyes drooped once the drug took effect.He disconnected her IVs, leaving the port taped into her elbow. He turned off her oxygen, peeled back the tape from her nasal cannula, and removed the prongs from her nose, careful not to dislodge her feeding tube taped to her right cheek. He inserted two fingers into the leg gathers of her diaper and squeezed the front. Despite the large doses of IV mannitol he gave her, which caused her to urinate frequently and uncontrollably, she was still dry and did not need a change before the walk.He picked his little girl up and set her down in her stroller. It was a large stroller meant for young adults with special needs. He got to work fastening the five-point harness, pulling the straps over her shoulders and hips and up between her legs, clicking the buckles shut at her chest and under her belly button. He tightened her straps and checked them, then tightened the crotch strap further. Daddy liked it when her crotch strap pressed firmly into her diaper. When she was more alert, she often complained about her car seat or stroller harness being too tight, but not today. She was too sleepy. He raised her chest clip high on her sternum, just under her collarbone. “Daddy has your chest clip up nice and high. It will keep your shoulder straps extra tight and help make sure you stay lying down the whole time we are on our walk. Daddy wouldn’t want you to try to sit up.”He reclined her stroller seat so she was lying almost completely flat before covering her bare legs, diaper, and chest with a blanket. He put her padded mittens on and tied them tightly around her wrists before tucking them under the blanket alongside her. Her thumbless mittens rendered her hands useless, another way her Daddy enjoyed keeping her nice and helpless.Finally, he brought the portable oxygen concentrator and the small canister of sleepy gas over and loaded them into the storage basket at the back of the stroller. He connected the oxygen mask and its tubing to the oxygen concentrator and set it to a high flow, which would help keep her dizzy and disoriented. He placed the mask on his little girl’s face, securing it with a strap that went snugly around the back of her head. She laid her head back, blinking sleepily under the effects of her sedation, breathing in her rapidly-flowing oxygen. Daddy smiled at her. “Yes. You’re feeling your sedation, aren’t you, honey? Just rest now. Nice, deep breaths in your mask. Your oxygen is turned up very high, so you may feel a little woozy from that, too. Daddy is helping you get sleepy and relaxed for our walk.” The little girl could barely comprehend his words. She was distant, detached, and finding it hard to fight through the sedation like she hoped she might be able to.“I think we’re all set!” said Daddy brightly. He steered his little girl in her stroller out into the warm spring sunshine. He paused and pulled the canopy of the stroller down to protect her from the sun before continuing down the driveway.The little girl was sedated, her harness was uncomfortably tight, she couldn’t sit up and look around, and her oxygen hissed loudly in her ears and poured up her nose and into her mouth, but she was aware enough to be grateful for the warmth of the sun on her blanket and the sweet sound of the chirping birds. It had been so long since she had left the house. She tried to push through her sedation so she could be ready to ask for help if anyone approached them. She took slow, deep breaths and tried to clear her head, but the highly concentrated oxygen made her dizzy. She tried to shift her body, but her harness restrained her. She lifted her head a bit, but it was too much effort, and she had to allow it to fall back against the soft cushioning of her stroller. She closed her eyes briefly but then forced them back open. She couldn’t let herself fall asleep. She had to stay awake. She needed to get her oxygen mask off and get someone’s attention. This might be her only chance.Daddy meandered through the streets of the neighborhood. He waved at neighbors in the distance and shouted hellos, but no one approached them. As they walked, the little girl found herself beginning to feel more alert. Though she was light headed from all the oxygen, her sedation was slowly wearing off. She tried to lift one of her mittened hands, but found her body was still too sleepy and heavy to move. If only her Daddy would keep walking for just a little while longer.“Well, long time, no see!” She heard a man’s cheerful voice. She could hear footsteps over the loud hiss of the oxygen in her ears. Someone was walking up to them! She blinked and swallowed, trying to force herself to wake up. She turned her head from side to side, trying to dislodge her mask. The effort made her intensely disoriented. The earth felt like it was lurching from beneath her and the mask stayed in place. She closed her eyes, willing the dizziness and sleepiness to pass. If only she could turn down the flow of her oxygen.“How are you?” she heard the neighbor ask her Daddy. “How’s the little one? Any better?”“We’re good,” Daddy replied. “And she’s doing okay. Thanks for asking. Still requiring oxygen around the clock and can only receive nutrition through her feeding tube, unfortunately.” Daddy pulled back the sun shade of her stroller and both men looked down at her. She blinked sleepily up at them. “Plus her rapid cognitive decline makes her very sleepy and disoriented all the time,” Daddy explained. “But we’re doing our best, aren’t we, sweetie?”“Awww,” said the neighbor with a sad smile. “What a brave girl. And what a devoted Daddy! The whole community is pulling for you guys. I can’t imagine how tough this must be with her being so sick. We’re all in awe of how lovingly you care for her.”As the men continued talking above her, the little girl used all her strength to raise one mittened hand from under the blanket. She stopped there and took a rest, breathing slowly in her mask, fighting her spinning head, and gathering her strength again. With all the effort she could muster, she pushed through the lingering effects of her sedation, lifted her mitten up to her face, and knocked her oxygen mask off her mouth and nose. It slid down by her chin and she rattled softly, “Help.”Both men stopped talking and looked down at her. Daddy’s expression changed immediately. He was furious. “Help,” the little girl whispered again, breathing in the fresh air and trying desperately to clear her head while she still could. She had done it! She had gotten her mask off! She had alerted the neighbor that she needed help! She was free of the overwhelming flow of oxygen. She couldn’t remember the last time she had been able to breathe fresh air freely on her own.Before Daddy could do anything, the neighbor was squatting down by the little girl’s stroller. “Uh oh, sweetheart,” he said kindly. “Did your oxygen mask come off? Let me help you.” He gently placed the mask back over her nose and mouth. The little girl’s eyes opened wide. No! This was not what was supposed to happen. She immediately felt the concentrated oxygen flowing back into her nose and mouth, making her lightheaded and woozy. She tried to struggle, but the straps of her harness held her down. “Thank you so much,” said Daddy. He reached for her oxygen concentrator. “I’m going to give her a little more oxygen. Can you do me a favor and hold her mask on her face while I get things adjusted? She gets pretty agitated and confused when her oxygen is interrupted and can have a hard time calming back down. You’ll need to use a firm grip on her mask because she’ll likely try to shake it off. You might also hear her trying to talk. She doesn’t know what she’s saying and it probably won’t make any sense. Don’t let it upset you. It’s just part of her cognitive decline, unfortunately.” “Of course,” the neighbor said. He adjusted his hold on her mask and pressed it down more firmly on her face. Her feeding tube dug uncomfortably into her cheek under the pressure. He smiled gently down at the little girl’s face as he held her mask. “Let’s get you tucked back in,” he said. He adjusted her blanket with his free hand, covering her exposed arm and mitten. He tucked the blanket tightly underneath her on both sides. “No,” the little girl said as loudly as she could through the mask. Her heart was pumping and her sedation was rapidly receding. She was dizzy, yet she felt almost fully alert, like her strength was returning. “Please. Stop.” She tried to speak as clearly as she could to let the neighbor know she was not confused. She tried to bring her hands up to unlock her chest clip and crotch buckle. If she could get free of her mask and harness, she could explain everything. The man had tucked her blanket in so tightly that she couldn’t lift her arms, and even if she could, Daddy had put her mittens on to make sure her harness would remain tightly fastened.The neighbor smiled tenderly and moved his free hand to her forehead, gently brushing her hair out of the way as he pressed the oxygen mask down over her nose and mouth. “Shhhh…” he hushed her. “Shhhh, little one. Everything is okay. I know you’re confused and I know it was scary when your mask came off. All you need to do is focus on breathing in and out. You’re safe and strapped into your stroller and your Daddy and I are both here making sure you get enough oxygen. Just relax and rest, honey.” Daddy could see his baby was becoming more awake. Working quickly, he connected the smaller canister to the oxygen concentrator and opened the valve to her sleepy gas wide, eager to prevent his baby from trying to communicate any further and to get her back under deep sedation. As soon as the little girl smelled the familiar gas fill her mask, she shook her head, trying even harder to escape. She didn’t want to go back to sleep and lose this one chance to get help. “No! Help!” she said again as loudly as she could through the mask and the hiss of the rushing gas. She desperately tried loosen the tight seal the mask had on her face. If only she could get a little more fresh air. The neighbor smiled down at her as he pressed her mask tightly on her face. “It’s okay, sweetie. I know you’re scared and confused. Your daddy is turning up your oxygen to help you breathe. Fill those lungs with slow, deep breaths. We’re right here taking care of you.” To her Daddy the neighbor said, “It’s a good thing you have her in a stroller with a five-point harness to keep her safely restrained. She really gets antsy when she’s agitated, doesn’t she? You wouldn’t want her to fall out.””Absolutely,” said her Daddy. “A five-point harness has unfortunately become necessary every time we leave the house nowadays, even though she really hates it when I tighten and buckle her crotch strap. Her mittens help too so she doesn’t accidentally scratch herself or try to remove her oxygen or unfasten her harness. It’s hard to see her so helpless, but it gives me great peace of mind knowing she’s safe and secure.”Daddy looked down at his little girl. She was working hard to fight against the effects of the sleepy gas that had filled her mask. She took shallow breaths and blinked rapidly, trying to stay awake. She struggled against the unyielding straps of her harness. “Do you mind lifting her chin a bit with your other hand?” Daddy asked the neighbor. “If you do that, it’ll open her airway more and help her get deeper breaths of her oxygen. That might help her calm down a little more quickly. Make sure her mask stays nice and tight against her face.” The neighbor pressed two fingers firmly up under the little girl’s chin, extending her neck as he continued to hold her mask firmly.Instantly the gas became more effective as it poured into the mask, down her throat, and into her lungs. The little girl was feeling its effects. She was still woozy from the excess oxygen, but now she was also tingly from the gas. Things were getting fuzzy and hazy in her mind. She was beginning to get confused and was trying hard to stay focused on escaping her mask and asking for help. She knew didn’t have much time left. She had to stay awake and alert. She had to seize this chance to get help. She tried to slow down her breathing, but her heart was racing and she knew she was gulping down the gas.She tried to lift her shoulders, but her harness straps and the man’s heavy grip on the mask and her chin forced her to stay reclined. She shifted her lower body, but the hip and crotch straps held her in place. Her arms felt leaden, as though pinned to her sides by the weight of the blanket the man had tucked tightly around her. Her eyelids were becoming heavy; she forced them to stay open. She tried to remember what was happening. Where was she? Why was she fighting? Who was this man pressing a mask to her face? Then she remembered: this is my chance! I need this man’s help! She tried to wiggle away from the mask. Why didn’t he understand that she needed to talk to him?The neighbor continued to hold her chin and mask and he smiled kindly down at her as he watched her fight. “Rest easy, baby. Your Daddy is giving you lots more oxygen and I’ll stay right here until you are all calmed down. Just take slow, deep breaths. I’ll keep holding your mask for you. You don’t need to worry about it falling off again.” The edges of the little girl’s vision were going dark as the gas poured into her mask, down her throat, and into her lungs. The two men stood over her, the neighbor kneeling close and her Daddy standing up behind him, looking down at her with rage. She blinked and tried to clear her head. Things were beginning to spin. She tried once more to shake off the mask and to sit up, but her harness was so tight and she was getting so sleepy. “No. Please,” she whispered desperately. The man held her mask and chin even more tightly against her movements. “Shhhh…” he soothed her. “That’s a good girl. Deep, slow breaths through your mask.” He forced her chin up higher with his fingers and the sleepy gas poured down her throat. She pushed down against her crotch strap, but it pressed up against her diaper, holding her in place. The darkness began to close in and the little girl could no longer fight against it. “There we go,” she heard the man say soothingly. “Good. Yes. That’s right. You’re feeling sleepy, aren’t you? No need to try and fight so hard. You know you need your mask and your oxygen.” His voice sounded very far away, like it was at the end of a long and echoing tunnel. The world was swirling and she was swirling with it, more confused and disoriented than ever. Her breathing became slow and even. “You can close your eyes, sleepy girl. Keep taking those nice, deep breaths. Let your mask help you. Breathe in all that good oxygen. Rest and relax. You’re doing a great job.” As her eyes glassed over, Daddy smiled. He knew she wouldn’t be able to fight or try to speak anymore. The danger had passed. The sedation had her in its grip and she was once again helpless. “Okay,” he said to the neighbor. “I think she’s all settled. You can let go of her chin and mask. Thank you so much for your help. Sweet girl doesn’t know what she’s doing and it’s so scary for her when she accidentally knocks off her mask. She just cannot breathe without supplemental oxygen anymore, I’m afraid.” The neighbor stood and both men looked down at her with sad smiles, one genuine and one forced. Daddy leaned over and tightened the strap that secured her oxygen mask to her face. “We don’t want this coming loose again, do we?” she heard him say, but his words were distant and foggy in her drugged mind. The sleepy gas and oxygen were pouring in so fast and she had stopped trying to fight. With every breath she fell deeper into the relentless sedation. The last thing she was aware of before she lost consciousness was Daddy pulling back her blanket and tightening the straps of her five-point harness. She felt the strap between her legs pressing even more tightly against her diaper and then there was nothing more.When she awoke, she was in her bedroom in her Daddy’s lap. He held her in the rocking chair next to her crib. Her bipap was secured to her face, delivering breaths rapidly. Her IV pole was above her, hung with a bag of her formula and several IVs. Her daddy had one arm wrapped around her, holding her tightly, and the other hand on her diaper and onesie snaps, rubbing gently. He was looking down at her as she blinked and gained awareness. The look in his eyes instantly filled her with fear.“That was some stunt you pulled,” he said quietly. “It was a good thing I had your sleepy gas all ready to go. Did you think you could escape that easily? Did you really think your Daddy would just let his baby girl go?”The little girl blinked, unable to respond from behind her large bipap mask, which covered her nose and mouth and was secured around her head with several tight Velcro straps. Her body felt heavy and sluggish and she knew Daddy had a muscle relaxant flowing in one of her IVs. “I’ll admit, it was kind of fun watching you realize our neighbor wasn’t going to help you escape. You thought all you had to do was take off your oxygen mask and ask for help and he would be your way out, didn’t you? But then he was the one who forced you to breathe in all your sleepy gas and go back under sedation. I loved getting to watch you try and fight so hard against your mask and your harness. But your little plan didn’t work, did it, honey? Here you are, back on your bipap with your IVs and formula running. Right where you belong.” She suddenly realized she was wetting her diaper without control. She felt it get heavy and warm. She tried to stop the flow, but could not. Daddy pressed his hand more firmly against her warming diaper. “Looks like your mannitol and muscle relaxants are doing their job, helping you wet your diaper like the helpless baby girl you are. Daddy was so surprised that for a moment you seemed to forget that you’re a baby who doesn’t get to make her own decisions.”He was quiet for a few minutes, gently rocking her and keeping one of his heavy hands on her wet diaper. He watched her chest rise and fall at the rate he had programmed her bipap, knowing she didn’t like the lack of control over her own breathing. “You know, baby. If the neighbor had helped you and you had managed to get away from Daddy, did you ever think about what would happen next? You’re dependent on oxygen now, even though I know you don’t want to believe it. You most likely can’t sleep without the support of your bipap anymore either. And what about your diapers? You’re fully incontinent and have been for a long time. Who would take care of all that for you? Did you ever stop and think about how hard Daddy works to take care of his little girl?” He looked down into her eyes. She blinked, trying to pay attention while struggling with the air being forced rapidly in and out of her lungs. “I didn’t think so,” he said with a frown. “My little girl has become very greedy and ungrateful.”Daddy was quiet again. He rocked his little girl, one hand firmly pressed between her legs on her wet diaper. He tightened a few of the Velcro straps securing her bipap mask to her face. Then he spoke again. “Because you were such a naughty girl when Daddy tried to be nice and take you on a walk and because you have become ungrateful for everything Daddy does for you, there are going to be some consequences. Firstly, your bipap is going to stay on around the clock for the next week.” The little girl’s eyes widened. He continued, “It’s possible that after a week on your bipap, you might not be able to breathe without it. Your lungs have already gotten a lot weaker since you’ve begun sleeping with the bipap all the time. And full week on the bipap with lots of supplemental oxygen flowing 24/7 will most likely make your lung strength a lot worse. If that happens, you’ll have to stay on your bipap permanently. Daddy might even need to intubate you. That means a long tube down your throat and into your lungs that is connected to a ventilator. Being intubated makes using a bipap look like a walk in the park. We shall see what happens.”Tears began to collect in the little girl’s eyes. She tried to speak through the mask. “Daddy, please.” She coughed as the air in her mask was forced down her throat as she spoke.“You know you can’t talk when your bipap is on, baby. It makes you cough. Hush now.” He rubbed her diaper more firmly while he looked down sternly in her eyes. “Daddy will keep your sedation going, of course, but it’s going to be nice and light. That way you’ll be mostly awake and aware during your week on the bipap. Daddy knows you try to fight your bipap when you’re awake, so this week will give you lots of time to practice accepting it and letting it do all your breathing for you.”Daddy stood then, holding his little girl in his arms like a rag doll. “There is something else that will be happening as a consequence of your bad behavior.” He leaned over then, lying her down on the crib mattress. “I bought this for you a while ago, but I haven’t found a reason to use it until today.” The little girl could feel something new and different underneath her limbs, but she couldn’t make out what it was. Then she felt a strap encircle her wrist and tighten. She looked over as much as the bipap would allow. Daddy was buckling a thick, white, canvas medical restraint around her wrist. She realized she was lying on top of many straps just like it. “This is called Segufix,” said Daddy. “It’s going to keep you safely restrained every time you are in your crib from now on. Now that I know my little girl is an escape artist who can’t be trusted, I need to be more strict and careful with you.”He began strapping down her other wrist. Once the straps were secure, the little girl’s limbs were immobilized. She moved her legs and tried to sit up, but the muscle relaxant was so powerful and the bipap mask felt so heavy. “No, baby. You’re not going anywhere,” Daddy said. He closed and tightened straps around her upper thighs, spreading them widely open. Next came the straps around her knees and ankles. Daddy pulled a wide strap around her stomach and locked it snugly closed before pulling another strap up between her legs. “Daddy had to get his little girl the Segufix set with the crotch strap,” he said with a smile. “I think we can put it on its tightest setting.” He cinched the strap over her wet diaper before locking it to the strap around her waist. The wet padding, now cold, pressed uncomfortably against her. “Now comes your shoulder straps,” he said. “It’s just like being in your car seat, but it’s in your crib,” he said. “I know you hate being in a five-point harness, but naughty girls have to be kept very safe and secure.” The straps running over her shoulders crossed over her chest before being tightened and locked to the wide strap around her waist. “Last but not least,” Daddy said, “This special strap goes around your neck. If you lie nice and still, it won’t bother you. But if you wiggle or try and escape, this strap will press on your neck and make it very hard to breathe, even with your bipap.” He looped the strap over her throat and locked it closed. Even when lying completely still, the pressure from the neck strap made it difficult for the little girl to swallow.Daddy stood back and looked at his little girl lying in her crib, tightly bound by her Segufix. “This week will give you time to think about what it means to be Daddy’s baby and how you should behave in the future.” He lifted the railing of her crib and locked it in place. He checked the formula running through her feeding tube and then turned his attention to her IVs. “Daddy is going to make sure you’re getting lots of mannitol so you keep wetting your diaper. I know you’re already wet, but Daddy isn’t going to change you just yet. Naughty girls don’t get nice, dry diapers right away like good girls do. I’m also going to start your sedation now. Remember, it’s going to be very light. It’ll probably make you feel restless because you’ll feel like you want to fall asleep, but you won’t really be able to. You’ll just feel foggy and probably a little confused.” He pressed several buttons the keypad on her IV pump and the medicine began to flow.Daddy turned the oxygen concentration up in the little girl’s bipap. “Here comes lots more oxygen, baby. Your bipap will be giving you very quick and deep breaths, so you’ll notice a strong feeling of light headedness, I’d imagine. But you’ll adjust. We’ll keep your oxygen flowing nice and high all week.” Then he sat down in the rocking chair and watched his little girl. Her feet flexed and her hands opened and closed as the sedation began to flow and made her feel restless. She tried to lift her wet diaper away from the pressure of the Segufix’s crotch strap, but the shoulder straps prevented any upward movement. She tried to turn her head, but the restraint around her neck put uncomfortable pressure on her airway and she immediately returned her head to facing forward. He watched her try and fight the control of the bipap as it delivered oxygen-rich breaths quickly and relentlessly. He smiled as she blinked rapidly, trying to clear her spinning and fuzzy head. It was going to be a tough week for her, but it would teach her a few important lessons: she was not in charge and she was not going anywhere. She would remain Daddy’s helpless little girl forever.